Preplanning Form

Planning for the end of life is something most of us prefer not to think about, but it’s an essential step in ensuring that our final wishes are honored, and our loved ones are provided with guidance during a difficult time.

Vital statistics are essential for a funeral home to accurately and efficiently process the necessary paperwork and provide a personalized and respectful service to the family.

To whom this plan is for:

Name

First Name

Last Name

Date of Birth

YYYY

Place of Birth

City, State, Country

Gender

Male

Female

Social Security Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Vital Information

Marital Status

Spouse/Partner Name (if applicable)

Mother’s Full Name (Maiden Name)

Father’s Full Name

Ethnicity

Highest Level of Education

Occupation

Type of Business/industry

Your Contact Information

Name

First Name

Last Name

Phone

(###)

###

####

Military

Military Service

Yes

Branch of Service

Years Served

Visitation

Provide other visitation location (optional)

Funeral

Funeral Service Options

Provide other funeral location (optional)

Reception

Reception Options

Provide other reception location (optional)

Disposition

Burial or Cremation?

Burial

Cremation

Name of Cemetery

For Burial or for ashes

Final resting place for ashes (if cremated)

Would you prefer a gravesite service?

Yes

Service Requests

Please list any musical selections you would like to include in your service

Please list any poems, religious texts, or readings you would like to be read at your service

Please list any special themes you would like to include into your service

Is there a special story, personal thank you, or message of hope you would like to be read during your service?

Preplanning Form

Blount Funeral and Cremation

Location

Contact